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April 2024 Challenge

Malcolm Needs

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Posts posted by Malcolm Needs

    Autocontrol positive .negative cross matching

    in Immunohematology Reference Laboratories

    Posted

    Most certainly, you need to have a thorough transfusion history on the patient, as my good friend Yanxia says above, but it also depends upon the condition of the patient.  If the patient is exsanguinating, the old adage comes into play that it is not a medical triumph to give perfectly compatible blood to a corpse, when, in very many cases these days, a haemolytic transfusion reaction can be treated.  HOWEVER, it is ALWAYS a decision to be made by a medically qualified person, rather than a laboratory qualified person to make, as to how urgent the transfusion may be.

    IF there is time, it is always worthwhile doing a few more investigations.  For example, is the patient DAT Positive, and, if so, is it IgG, IgM, IgA (rare), complement or a combination?  Is the reaction seen in the auto-control due to a "cold" auto-antibody, or something else.

    To repeat what I wrote above, it MUST always be a decision for a medically qualified person, rather than a "lab rat" (HATE that term, but I hope you know what I mean, without taking offence - being a retired "lab rat" myself), but, if it was a case with which I was dealing, apart from doing a few basic tests (see above) I would be happy to give the blood - and more importantly, receive the blood, if I were the patient.

    Massive Transfusion Recipient

    in Transfusion Services

    Posted

    5 minutes ago, jshepherd said:

    RhIg after giving 12 Rh pos units is futile. The patient will either make anti-D or not, too late to prevent at this point without exchange transfusion, which seems like overkill. We always say the female of childbearing age has to live in order to worry about anti-D in a future pregnancy, so we worry about that first. :)

    Our policy is to revert to the patient's actual type after a massive situation. We would give A neg. Now, if the patient starts massively bleeding again, we would revert to A pos. Until the patient makes that anti-D of course. 

    Even though you've already given Rh pos to this patient, you did it during a mass transfusion, which is physiologically different than tranfusing an Rh pos unit low and slow. 

    I agree entirely, EXCEPT, we should think of females of child bearing POTENTIAL, rather than child bearing AGE.  Think, for a moment, of a female who is group A, D Negative, who is, for example, 11 years old.  Sorry to be picky, but, so often, these female children do not get the anti-D immunoglobulin they should be given.

    2024 Challenges

    in Site Comments / Suggestions

    Posted

    7 hours ago, Antibodiesrock said:

    I heard a lecture a while back, and I can’t find my notes, but I believe this could be the Er blood group system :confused:

    Absolutely spot on.  Well done!

    See Karamatic Crew V, Tilley LA, Satchwell TJ, Al Subhi SA, Jones B, Spring FA, Walser PJ, Martins Freire C, Murciano N, Giustina Rotordam M, Woestmann SJ, Hamed M, Alradwan R, Al Khrousey M, Skidmore I, Lewis S, Hussain S, Jackson J, Latham T, Kilby MD, Lester W, Becker N, Rapedius M, Toye AT, Thornton NM.  Missense mutations in PIEZO1, encoding the Piezo 1 mechanosensory protein, define the Er red blood cell antigens.  Downloaded from http://ashpublications.org/blood/article-pdf/doi/10.1182/blood.2022016504/1922096/blood.2022016504.pdf on 30th September 2022.

     

    2024 Challenges

    in Site Comments / Suggestions

    Posted

    1 hour ago, MGM said:

    Well, its a multi-pass protein blood group so could be RH; Diego, Lewis ruled out.  Kidd would be lacking proteins for Kidd null.   Just a guess.  

    I'm afraid not.  Many of the Blood Group Systems are multi-pass proteins.

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